ACO & DCE Toolkit for Taking Risk

Doubling down its efforts to transition all fee-for-service programs to value-based care, the Centers for Medicare & Medicaid Services (CMS) has continued to push Accountable Care Organizations (ACOs) to take on more downside risk while also bringing new alternative payment models, such as Direct Contracting Entities (DCEs), to the market.

For many ACOs hit hard by the pandemic, managing risk has become more important than ever. This will also be critical for newly-formed DCEs as they prepare for their first performance year in 2021. Thus, we have created a comprehensive toolkit for DCEs and ACOs to successfully manage risk while improving patient outcomes.

Key Takeaways:

• Know who your patients are: Knowing which beneficiaries are actually part of an ACO or DCE is the first step to managing cost and improving outcomes
• Know who to manage and how: Identifying which patients to focus on and how to manage them is key to ensuring those who are attributed to you stay attributed to you
• Interoperability: Being able to connect to a data broker will be critical to helping ACOs and DCEs get clinical data in advance of CCLF delivery, which has some lag
• Benchmarking: Understanding the important role risk adjustment plays in benchmarking can make the difference between having savings and not